INVOLUNTARY DISCHARGE (IVD) PROCESS THURSDAY, AUGUST 24, PM CST

Transcription

1 INVOLUNTARY DISCHARGE (IVD) PROCESS THURSDAY, AUGUST 24, PM CST

2 LEARNING OBJECTIVES To provide direction to dialysis facility practitioners on how to complete Involuntary Discharge (IVD) Paperwork Before the Involuntar y Discharge Occur s How to notify the Network without violating HIPAA Examples Terms Resources available online Patient Issues Algorithm Bed Bug Protocol Help with Behavioral Agreements During the Involuntar y Discharge Checklist Internal Processes at the Network Immediate Discharge Reasons for Discharge 30-Day Discharge Reasons for Discharge Outcomes from Network Pre-Survey Results Evaluation Link

3 DISCLOSURES Disclosures: Requirements for successful completion CEU certificates after September 15, 2017 (Social Workers only) Conflicts of Interest None Commercial Support None Joint Providers None

4 HOW TO NOTIFY THE NETWORK WITHOUT VIOLATING HIPAA

5 Hello Rechelle, We had a patient at our XXXXXXXX location who made homicidal and suicidal threats towards his wife and children. The threats were on Facebook in a message to his sister-in-law (wife s sister). The patient stated that he would kill his wife, everyone in their home, and then himself. The patient s wife came to the dialysis center on the date of this and reported these threats to the center. The center called the police (report made), and the center encouraged the wife to call the police as well. This LMSW called the patient s wife and confirmed a safety plan, and also encouraged the patient to seek the police s assistance. This LMSW also gave the patient s wife the number to a family safety shelter. The facility has placed the patient on an unstable plan of care due to the safety concerns for himself and his family. Police did go to the residence, but the police officer did not reveal that he was looking for the patient. He stated he was looking for the patient s wife. The patient s wife will be going to her sister s home for safety. We are sending this as a notification of what is going on with the patient, what we have done, and what we are planning to do. We will be completing an unstable assessment. If the patient agrees, we will contact the mobile crisis team to assess the patient further. I can call you to give the patient PHI in a secure manner on Monday. Facility: XXXXXXXXXX #CCN XXXXXX Phone Number: XXX-XXX-XXXX XXXXXX, DaVita

6 F r o m : K i m b e r l y A P o w e r s [ m a i l t o : Ki m b e r l y. P o w e r f m c - n a. c o m ] S e n t : F r i d a y, A u g u s t 1 8, : 1 3 P M T o : B r o w n, R e c h e l l e C c : XXXXXXX S u b j e c t : N o t i f i c a t i o n o f I m m e d i a t e I V D I m p o r ta n c e : H i g h R e c h e l l e, P l e a s e a c c e p t t h i s e m a i l a s n o t i c e o f a n I m m e d i a t e I V D t h a t i s o c c u r r i n g a t o u r c l i n i c t o d a y. I w i l l f a x y o u a c o p y o f t h e s p e c i f i c s w i t h p a t i e n t i n f o r m a t i o n w i t h i n 3 0 m i n u t e s. T h e r e a s o n f o r t h e I m m e d i a t e I V D i s d i r e c t t h r e a t s o f p e r s o n a l s a f e t y b y t h e p a t i e n t a n d h i s w i f e t o a n e m p l o y e e. T h e c o n v e r s a t i o n c o n t a i n i n g t h e t h r e a t s w e r e w i t n e s s e d b y t w o s t a f f m e m b e r s, o u r C l i n i c M a n a g e r, S a r a h, R N, a n d m y s e l f. O u r R e g i o n a l D i r e c t o r o f O p e r a t i o n s, XXXXX, i s p r e s e n t i n t h e c l i n i c. S h e i s m a n a g i n g t h e s i t u a t i o n w i t h XXXXX. T h e p a t i e n t i s c u r r e n t l y c o m p l e t i n g t r e a t m e n t f o r t o d a y. I a m p r e p a r i n g a l l t h a t i s n e c e s s a r y a c c o r d i n g t o t h e I V D c h e c k l i s t a n d o u r i n t e r n a l p o l i c y / proce d ure. W e a n t i c i p a t e h a v i n g t h e o p p o r t un i t y t o o f f e r t h i s p a t i e n t a m o v e t o a n o t h e r F r e s e n i u s c l i n i c i n L u b b o c k a n d t o k e e p h i s c u r r e n t n e p h r o l o g i s t. H o w e v e r, t h i s w i l l b e t h e p a t i e n t ' s c h o i c e. P l e a s e l e t m e k n o w i f y o u h a v e a n y f u r t h e r n e e d s o r q u e s t i o n s. T h a n k y o u, K i m b e r l y A P o w e r s, L M S W H e a r t o f L u b b o c k D i a l y s i s S o c i a l W o r k A v e n u e Q L u b b o c k T X T I F k i m b e r l y. p o w e r f m c - n a. c o m

7 TERMS CLINIC 1. Self-Determination 2. Getting Patients Involved in Their Care CMS 1. Patient-Centered Care (PCC) 2. Patient Engagement (PE) 3. Including Family in Patient s Care 3. Family Engagement

8 TOOLS FOR SELF-DETERMINATION/PCC Suggested Tools Decreasing Patient Conflict (DPC) Modules Motivational Interviewing (MI) Modules Any others?

9 Source: Instruments/QualityInitiativesGenInfo/Downloads/Person-and-Family-Engagement-Strategic- Plan pdf

10 SELF-MANAGEMENT VS. SELF-CARE SELF-MANAGEMENT Dynamic, interactive, and daily process in which individuals engage to manage a chronic illness (Lorig & Holman, 2003). Refers to the ability of the individual, in conjunction with family, community, and healthcare professionals, to manage symptoms, treatments, lifestyle changes, and psychosocial, cultural, and spiritual consequences of health conditions (Richard & Shea, 2011) SELF-CARE Healthy lifestyle behaviors are undertaken by individuals for optimal growth and development, or the preventive strategies performed to promote or to maintain health (Richard & Shea, 2011; Riegel & Dickson, 2008)

11 SELF-MANAGEMENT VS. PATIENT EDUCATION Self- Management Patient Education Problem solving related to consequences of disease Patient identified problems Self-directed behaviors to improve clinical outcomes Disease Specific Information Inadequate control of disease Compliance with behavior change Increasing patient knowledge does not always lead to a behavioral change!

12 Patients must be able to apply gained information to their REAL LIFE situations

13 WHAT IS MOTIVATIONAL INTERVIEWING?

14 TOOLS FOR GETTING PATIENTS AND FAMILY INVOLVED IN THEIR CARE/PE Suggested Tools Facility Patient Representatives (FPR) Motivational Interviewing (MI) Modules The Beryl Institute Institute for Patient- and Family-Centered Care (IPFCC)

15 FACILIT Y PATIENT REPRESENTATIVE (FPR)

16 RESOURCES AVAILABLE ONLINE

17 HELP WITH BEHAVIORAL AGREEMENTS Notify patients if their behavior could lead to termination of services and steps they can take to change their behavior (i.e. behavioral agreement). Outline steps (i.e. do not yell at staff members, do not use racial slurs, do not throw things). Give the patient the opportunity to succeed (on an unstable care plan each month to monitor the progress of the expectations for the patient and clinic). The clinic staff uses their clinical judgment as to when the involuntary discharge process starts after ALL of the CMS Conditions for Coverage (CFCs) required steps have been completed.

18 BEHAVIORAL AGREEMENTS- CONTINUED Individualized to the patient. The agreement identifies the patient s reason(s) for the behavior. Informs the patient of the potential consequences if the disruptive behavior continues or worsens. Change of shift, discharge, transfer to another clinic, etc. The agreement identifies the problem behavior. Defines the actions to be taken by the patient and the staff that will help prevent the behavior from happening again. The agreement reiterates Patient s Rights and Responsibilities. The agreement reiterates Facility Staff s Rights and Responsibilities.

19 CHECKLIST Review and have documentation to support that clinic has followed the steps to ensure Self-Determination, PCC, PE, and family engagement. Internal Policies Patient Issues Algorithm (if applicable) Tip Sheet 1 Tip Sheet 2 Bed Bug Protocol (if applicable) Local Resources (if applicable) Mental Health Substance Abuse Transportation Acute Care (Hospitals for non-payment patients) Call the Network the same day letter is given to the patient (30-day or Immediate Discharge). If is sent, be mindful not to violate HIPAA.

20 CHECKLIST- CONTINUED Fax IVD packet information to the Network within 48 hours of notification. Include fax confirmation that the State of Texas was notified with the "IVD packet" that was sent to the Network. Provide any additional documentation requested by the Network. Finding Placement If 30-day IVD, assist the patient with placement options. If Immediate IVD, at the minimum, provide the patient with a list of local emergency rooms for dialysis care. If the nephrologist discharges the patient from their care, the responsibility falls on the clinic to complete the IVD packet.

21 CHECKLIST- CONTINUED CROWNWeb Immediate IVD The date that the patient was actually discharged, if sustained/substantiated by the Network, is entered into CROWNWeb. 30 Day IVD The date of the discharge letter, if sustained/substantiated by the Network, is entered into CROWNWeb.

22 IMMEDIATE IVD: NW INTERNAL PROCESS NW staff receives call from a facility (notification) NW sends Records Review" for sustainment, missing documents, or ed results NW staff updates report for PSD (5th of month) NW receives requested paperwork from facility NW does an internal review of records received NW staff verifies discharge date in CROWNWeb if sustained -same day facility calls

23 REASON FOR DISCHARGE- IMMEDIATE IVD Immediate - severe threat to health and safety of others Bed Bugs Verbal Threats Threat to Hurt Others Gun Knife Other /Additional

24 30-DAY IVD: NW INTERNAL PROCESS NW receives call from a facility, NW reminds facility it is a 30- day process, then facility change status in CROWNWeb NW sends Records Review" for sustainment, missing documents, or ed results NW staff updates report for PSD (5th of month) NW receives requested paperwork from facility NW does an internal review of records received NW staff verifies discharge date in CROWNWeb if sustained - 30 DAYS LATER (follow/up status)

25 REASON FOR DISCHARGE- 30-DAY DISCHARGE Facility ceases to operate Non-Payment for services ordered Cannot meet documented medical needs Ongoing disruptive and abusive behavior Verbal or Written Abuse: Use of words, written or spoken, that demean, insult, belittle or degrade a person. Verbal or Written Threat: Use of words, written or spoken, expressing intent to harm, abuse, or commit violence toward a person or the facility. Physical Threat: Gestures or actions expressing intent to harm, abuse or commit violence toward a person or the facility. Physical Harm: Any injury or attack upon a person or the facility. Property damage/theft: Theft or damage to property on premises of the dialysis facility.

26 OUTCOMES FROM NET WORK

27 Total Cases MENTAL HEALTH AND SUBSTANCE ABUSE 7 30-Day IVD Mental Health and Substance Abuse Totals by Quarter (2017 Q Q1) Mental Health Substance Abuse 1 0 Q Q2 Q3 Q4 Q Totals by Quarter

28 Total Cases 30-DAY, IMMEDIATE, AND AVERTED IVDS DAY, Immediate and Averted IVD Totals by Quarter (2017 Q Q1) Day IVD Immediate Averted 2 0 Q Q2 Q3 Q4 Q Totals by Quarter

29 Total Cases Total Cases GENDER AND RACE OF IVDS GENDER Gender Totals By Quarter (2017 Q Q1) Male Female Q Q2 Q3 Q4 Q Black RACE Race Totals By Quarter (2017 Q Q1) White Q Q2 Q3 Q4 Q1-2018

30 Total Cases Total Cases ETHNICITY AND AVERTED OUTCOMES OF IVDS Hispanic ETHNICIT Y Ethnicity Totals By Quarter (2017 Q Q1) Non-Hispanic Q Q2 Q3 Q4 Q AVERTED OUTCOMES IVD Cases by Averted Outcomes (2017 Q Q1) At Facility Transferred

31 Total Cases IVDS DISCHARGE REASONS IVD Cases by Discharge Reason (2017 Q Q1) Severe Threat Non-Payment Disruptive Medical Needs (unmet) Other Q1 Q2 Q3 Q4 Q1-2018

32 Total Cases IVDS BY AFFILIATION CODE IVDs by Affiliation Code (2017 Q Q1) A B C D E F G H I J Q1 Q2 Q3 Q4 Q1: 2018

33 PRE- SURVEY RESULTS

34 Survey Participants N=41 Social Worker Secretary Regional Social Worker Facility Administrator Clinical Coordinator Clinic Manager Administrator Assistant Administrator

35 60.00% How soon should the IVD packet be sent to the Network? N= % 50.00% 40.00% 36.59% 30.00% Responses 20.00% 10.00% 0.00% 0.00% 24 hours of notification 48 hours of notification No limit, just get to it when you can 7.32% After case closed

36 90.00% 80.00% Which is not a valid reason for an IVD? N= % 70.00% 60.00% 50.00% 40.00% Responses 30.00% 20.00% 10.00% 0.00% 21.05% 0.00% 0.00% Non-payment Ongoing disruptive behaviors Non-compliance Immediate and Severe Threat to others

37 120.00% % The IVD process is located on the ESRD website. N= % 80.00% 60.00% Responses 40.00% 20.00% 0.00% True 2.63% False

38 90.00% 80.00% 81.58% The IVD process information is located at on the ESRD website N= % 60.00% 50.00% 40.00% Responses 30.00% 20.00% 10.00% 7.89% 5.26% 5.26% 0.00% Professionals then Social Work Tools Quality Improvement Activities Patient Engagement None of the above

39 90.00% 80.00% As a dialysis facility, do you have to notify the state of an IVD? N= % 70.00% 60.00% 50.00% 40.00% Responses 30.00% 20.00% 18.42% 10.00% 0.00% True False

40 90.00% 80.00% Who is responsible for notifying the State of an IVD? N= % 70.00% 60.00% 50.00% 40.00% Responses 30.00% 20.00% 10.00% 0.00% 18.42% 0.00% 0.00% 0.00% The Network The dialysis facility The patient Your neighbor The doctor

41 WHAT IS THE DIFFERENCE BETWEEN A 30 -DAY IVD AND AN IMMEDIATE DISCHARGE? A 30-day IVD gives the patient 30 days before discharge whereas an immediate discharge happens immediately. 30-day notice verses no notice. With a 30-day IVD, the patient and the facility have 30 -days to try to find the patient a new dialysis facility (or find solutions). The patient can continue to receive treatment until the 30-day deadline. With an immediate discharge, the patient must exit the building and can no longer dialyze at the facility again.

42 80.00% Who is responsible for finding placement options for the patient during the 30-day IVD process? N= % 70.00% 60.00% 50.00% 40.00% Responses 30.00% 23.68% 20.00% 10.00% 0.00% 2.63% 0.00% 0.00% The Network The dialysis facility The patient Your neighbor The doctor

43 120.00% % Can a patient be treated in a dialysis facility without doctor's orders? N= % 80.00% 60.00% Responses 40.00% 20.00% 0.00% 0.00% True False

44 WHAT WOULD BE A DISCHARGE REASON FOR THE PREVIOUS QUESTION? Cannot meet documented medical needs

45 EVALUATION LINK Rechelle Brown, LMSW EVALUATION LINK

46 LEARNING OBJECTIVES To provide direction to dialysis facility practitioners on how to complete Involuntary Discharge (IVD) Paperwork Before the Involuntar y Discharge Occur s How to notify the Network without violating HIPAA Examples Terms Resources available online Patient Issues Algorithm Bed Bug Protocol Help with Behavioral Agreements During the Involuntar y Discharge Checklist Internal Process at the Network Immediate Discharge Reasons for Discharge 30-Day Discharge Reasons for Discharge Outcomes from Network Survey Results Evaluation Link

47 REFERENCES Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self - management approaches for people with chronic illness: A review. Patient Education and Counseling. 2002;48(2): Bodenheimer, T. et. al. Innovations in Primary Care 2002; 288 (19); Haynes RB. Determinants of compliance: The disease and the mechanics of treatment. Baltimore MD, Johns Hopkins University Press, Lorig K, Holman H. Self-management education: History, definition, outcome and mechanisms. Annals of Behavioral Medicine. 2003;26(1):1 7.

48 REFERENCES Miller, L. Neuropsychological assessment of substance abusers: Review and recommendations. Journal of Substance Abuse Treatment 2(1):5 17, 1985a. Miller, W.R. Alcoholism scales and objective assessment methods: A review. Psychological Bulletin 98:84 107, Miller, W.R. Motivational interviewing with problem drinkers. Behavioral Psychotherapy 11: , Miller, W.R. Motivation for treatment: A review with special emphasis on alcoholism. Psychological Bulletin 15698(1):84 107, 1985b.

49 REFERENCES Miller, W.R. Increasing motivation for change. In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 2nd ed. Boston: Allyn &Bacon, pp Miller, W.R. What is a relapse? Fifty ways to leave the wagon. Addiction 91(Suppl.):S15 S27, Miller, W.R.; Andrews, N.R.; Wilbourne, P.; and Bennett, M.E. A wealth of alternatives: Effective treatments for alcohol problems. In: Miller, W.R., and Heather, N., eds. Treating Addictive Behaviors: Processes of Change, 2nd ed. New York: Plenum Press, pp

50 REFRENCES Miller, W.R., and Baca, L.M. Two year follow up of bibliotherapy and therapist directed controlled drinking training for problem drinkers. Behavior Therapy 14: , Miller, W.R.; Benefield, R.G.; and Tonigan, J.S. Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. Journal of Consulting and Clinical Psychology 61(3): , Miller, W.R.; Brown, J.M.; Simpson, T.L.; Handmaker, N.S.; Bien, T.H.; Luckie, L.F.; Montgomery, H.A.; Hester, R.K.; and Tonigan, J.S. What works? A methodological analysis of the alcohol treatment outcome literature. In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 2nd ed. Boston: Allyn &Bacon, 1995a. pp

51 REFERENCES Miller, W.R., and C'de Baca, J. Quantum change: Toward a psychology of transformation. In: Heatherton, T., and Weinberger, J., eds. Can Personality Change? Washington, DC: American Psychological Association, pp Miller, W.R.; Gribskov, C.J.; and Mortell, R.L Effectiveness of a self control manual for problem drinkers with and without therapist contact. International Journal of the Addictions 16: , Miller, W.R., and Heather, N., eds. Treating Addictive Behaviors, 2nd ed. New York: Plenum Press, 1998.

52 REFERENCES Miller, W.R., and Kurtz, E. Models of alcoholism used in treatment: Contrasting AA and other perspectives with which it is often confused. Journal of Studies on Alcohol 55: , Miller, W.R.; Leckman, A.L; Delaney, H.D.; and Tinkcom, M. Long term follow up of behavioral self control training. Journal of Studies on Alcohol 53(3): , Miller, W.R., and Meyers, R.J. Engaging unmotivated individuals in treatment for alcohol problems: A comparison of three intervention strategies. Journal of Consulting and Clinical Psychology, in press.

53 REFERENCES Miller, W.R., and Page, A.C. Warm turkey: Other routes to abstinence. Journal of Substance Abuse Treatment 8: , Miller, W.R., and Pechacek, T.F. New roads: Assessing and treating psychological dependence. Journal of Substance Abuse Treatment 4:73 77, Miller, W.R., and Rollnick, S. Motivational Interviewing: Preparing People To Change Addictive Behavior. New York: Guilford Press, Miller, W.R., and Sanchez, V.C. Motivating young adults for treatment and lifestyle change. In: Howard, G., and Nathan, P.E., eds. Alcohol Use and Misuse by Young Adults. Notre Dame, IN: University of Notre Dame Press, Miller, W.R., and Saucedo, C.F. Assessment of neuropsychological impairment and brain damage in problem drinkers. In: Golden, C.J.; Moses, J.A., Jr.; Coffman, J.A.; Miller, W.R.; and Strider, F.D., eds. Clinical Neuropsychology: Interface With Neurologic and Psychiatric Disorders. New York: Grune &Stratton, pp

54 REFERENCES Miller, W.R., and Sovereign, R.G. The check up: A model for early intervention in addictive behaviors. In: Loberg, T.; Miller, W.R.; Nathan, P.E.; and Marlatt, G.A., eds. Addictive Behaviors: Prevention and Early Intervention. Amsterdam: Swets &Zeitlinger, pp Miller, W.R.; Sovereign, R.G.; and Krege, B. Motivational interviewing with problem drinkers: II. The Drinker's Check up as a preventive intervention. Behavioral Psychotherapy 16: , Miller, W.R., and Taylor, C.A. Relative effectiveness of bibliotherapy, individual and group self control training in the treatment of Enhancing Motivation for Change in Substance Abuse Treatment problem drinkers. Addictive Behaviors 5:13 24, 1980.

55 REFERENCES Miller, W.R.; Taylor, C.A.; and West, J.C. Focused versus broad spectrum behavior therapy for problem drinkers. Journal of Consulting and Clinical Psychology 48: , Miller, W.R., and Tonigan, J.S. Assessing drinkers' motivation for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behaviors 10(2):81 89, Miller, W.R.; Westerberg, V.S.; and Waldron, H.B. Evaluating alcohol problems. In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 2nd ed. Boston: Allyn &Bacon, 1995b. pp Miller, W.R.; Zweben, A.; DiClemente, C.C.; and Rychtarik, R.G. Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence. Project MATCH Monograph Series, Vol. 2. NIH Pub. No Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, 1995c.

56 REFERENCES Rand CS. Measuring adherence with therapy for chronic diseases: implications for the treatment of heterozygous familial hypercholesterolemia. American Journal of Cardiology,1993, 72:68D-74D. Richard AA, Shea K. Delineation of self-care and associated concepts. Journal of Nursing Scholarship. 2011;43: Riegel B, Dickson VV. A situation-specific theory of heart failure self-care. Journal of Cardiovascular Nursing. 2008;23(3):

57 REFERENCES Sabate E.WHO Adherence Meeting Report. Geneva,World Health Organization, Schulman-Green D, Jaser S, Martin F, et al. Processes of Self - Management in Chronic Illness, J Nurs Scholarsh. 2012;44: